Job Description

Purpose:
We are seeking a detail-oriented individual to manage the manual processes involved in applying PPO guidelines to medical bills accurately and efficiently.

Essential Job Functions:

Provider Identification: Determine whether a provider is participating or non-participating when the automated matching process cannot do so.
PPO Guidelines Application: Accurately apply PPO guidelines to bills when a participation match has been made, but the automated re-pricing process cannot apply these guidelines.
Client and Internal Communication:
Request bill images or documentation from clients and internal Bill Review staff via email or phone to properly apply PPO discounts.
Address and rectify keying errors or discrepancies with appropriate parties to ensure accurate application of PPO discounts.
Team Collaboration: Engage with the PPO Application team through email, phone, or in person to discuss questions and concerns regarding specific bills or general policies and procedures.
Software Utilization: Use the appropriate software and documents to calculate contracted rates, which may include the calculation of AWP, Medicare, or state/federal-mandated fee schedules.
Quality Assurance: Assist the Senior PPO Application Specialist with the quality assurance process as needed.
Education:

High School Diploma or equivalent required.
Required Experience and Skills:

Familiarity with medical bill processes, including knowledge of CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Proficiency in Windows-based software/applications.
Accurate typing skills.
Ability to review documentation and make informed decisions based on department policies and procedures.
Strong interpersonal skills and the ability to work well in a team environment.
Self-motivation and the ability to take initiative.
Equal Employment Opportunity Statement:

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Local area,

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